tbuckley/cabot-search huggingface dataset:
Abstract P517: Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Eric K Broni, Oluseye Ogunmoroti, Olatokunbo I Osibogun, Justin B Echouffo Tcheugui, Parag A Chevli, Michael D Shapiro, Chiadi E Ndumele, Erin D Michos
Journal: Circulation (2023)

Introduction: Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal cardiovascular health (CVH) was introduced to monitor and promote 7 (now 8) key health factors and behaviors in the general population. Although prior studies have found strong associations between obesity and ideal CVH, the link between CVH and adipokines has not been elucidated. We examined the associations between CVH and adipokine levels in MESA. Methods: We studied 1,842 MESA participants who were free of cardiovascular disease at baseline, had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting blood glucose) measured at exam 1 (2000-2002) and adipokine levels measured at either exam 2 or 3 (2002-2004 or 2004-2005). Each metric was assigned a score of 0(poor), 1(intermediate) and 2(ideal), and summed to obtain a total CVH score (0 -14). We used multivariable linear regression models to assess the non-concurrent cross-sectional associations between CVH score and log-transformed serum adipokine levels, adjusting for sociodemographic factors. Results: The mean ± SD age was 62.1 ± 9.8 years and 50.2% of participants were men. Median (IQR) adiponectin, leptin and resistin levels were 17.4 (11.8 - 26.3) mcg/mL,13.3 (5.6 - 28.2) ng/mL and 15.0 (11.9 - 19.0) ng/mL, respectively. A 1 unit higher CVH score was significantly associated with 4% higher adiponectin, 15% and 1% lower leptin and resistin levels respectively, after adjusting for sociodemographic factors. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels compared to those with inadequate CVH scores. Similar results were obtained for those with average scores (Table). Conclusion: In a multi-ethnic cohort free of cardiovascular disease at baseline, individuals with average and optimal CVH scores had higher adiponectin and lower leptin and resistin levels compared to those with inadequate CVH scores.
Abstract MP17: Geographic Variations in Diet Quality Among Adults in the United States
Authors: Junxiu Liu, Zhuo Chen, Lan Mu, Yan Li, Janani R Thapa, Jose Pagan, Donglan Zhang
Journal: Circulation (2023)

Introduction: Prior studies of diet quality in the United States (US) have focused on national estimates and trends. Examining geographic variations in diet quality over time can provide actionable and targeted policy insights. Hypothesis: Diet quality is heterogeneously distributed across US geographical locations with higher diet quality in urban and western and eastern regions. Methods: We included a nationally representative sample of US adults aged 20 years or older with data on 24-hour dietary recall and geocode (N=19,607) from six cycles (2007-2018) of the National Health and Nutrition Examination Survey (NHANES). Exposures are geographic location by rurality, level of urbanization (large, medium, and small), and US census region and calendar year. Outcomes are diet quality measured by the American Heart Association dietary primary (range 0-50; based on total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverage, and sodium); secondary scores (range 0-80; adding nuts/seeds/legumes, processed meat, and saturated fat); the Healthy Eating Index (HEI) 2015 (range 0-50); major dietary components; and poor diet quality. Poor diet was defined according to the AHA secondary score as less than 40% adherence (score &lt;32); intermediate, as 40% to 79.9% adherence (score 32-63.9); and ideal, as at least 80% adherence (score ≥64, respectively). Results: Among rural vs. urban residents, the primary AHA, secondary AHA, and HEI-2015 scores in 2017-2018 were 19.5 (95% CI, 18.9-20.1) vs. 20.6 (95% CI, 20.4-30.0); 35.1 (95% CI, 34.3-35.8) vs. 37.1 (95% CI, 36.7-37.6), and 51.8 (95% CI, 51.0-52.7) vs. 53.9 (95% CI, 53.9-54.4), respectively. The corresponding proportions having poor diet quality for rural vs. urban were 43.1% (95% CI, 40.8%-45.5%) vs. 36.2% (95% CI, 34.8%-37.5%). By region, the AHA secondary score was lowest (34.9; 95% CI, 34.1-35.6) for the South. Similar result patterns were found for the AHA primary and HEI-2015 scores. The proportion of adults having poor diet quality was highest in the South (43.2%; 95% CI, 40.8%-45.6%). Trends in diet quality remained stable from 2007 to 2018. Conclusions: Significant differences in diet quality by rurality, levels of urbanization, and region exist for adults in the US. These differences in diet quality have remained stable from 2007 to 2018. Geographic differences in diet quality—and the consistency of these differences over time—seem to be important in the development of targeted food policy strategies to address regional disparities.
Abstract P644: Engagement With a Weight Loss Program for Postpartum Individuals at Elevated Cardiovascular Risk: A Qualitative Study
Authors: Hilary Bediako, Kelly Allison, Tricia Leahey, Sarah Stupp, Valerie Riis, Lisa Levine, michal elovitz, Judy Shea, Jennifer Lewey
Journal: Circulation (2023)

Background: Rising rates of postpartum obesity increase risk for cardiovascular (CV) disease, especially among individuals with adverse pregnancy outcomes. Engagement in weight loss programs (WLP) have not been well studied in the postpartum period. Our objective was to understand barriers to engagement in an online behavioral WLP among a racially diverse postpartum population with CV risk factors. Methods: We conducted a qualitative study of participants enrolled in a clinical trial. We identified individuals who were 3-12 months postpartum, had a body mass index ≥ 27 kg/m2, and had ≥1 of the following: chronic hypertension, hypertensive disorder of pregnancy, gestational or pre-gestational diabetes. We randomized 60 subjects 1:2 to usual care or online WLP based on the Diabetes Prevention Program. We conducted semi-structured virtual interviews with participants in the WLP who completed final assessments to understand barriers to and facilitators of program engagement. Interviews were recorded and transcribed, a codebook was developed iteratively with concurrent interrater reliability assessment, and themes were identified using content analysis. Results: Of 26 eligible participants, 20 completed interviews (77%). Mean age was 35 years and 45% were Black. Common barriers to program engagement were a lack of time due to competing life priorities and stressors, coupled with insufficient program personalization and peer support (see Table). In terms of facilitators, participants discussed intentionality, creating a routine to complete program requirements (e.g., daily morning weights) and specific aspects of the program structure (e.g., weekly feedback) as playing important roles in maximizing program engagement. Conclusion: Participants identified several opportunities to improve program engagement and weight loss success among postpartum individuals in future studies. These strategies will be critical to the implementation of future lifestyle interventions using remote technology in this population.
Abstract P403: <i>In Situ</i> Physiological and Behavioral Monitoring With Digital Sensors for Cerebrovascular Disease: A Scoping Review
Authors: Stephanie J Zawada, Naser H Aissa, Arjun P Athreya, Benjamin D Pollock, Bradley J Erickson, Bart M Demaerschalk
Journal: Circulation (2023)

Background: Cerebrovascular disease is a life-threatening neurological event and a leading cause of long-term disability and death worldwide. Early detection of characteristic behavioral and physiological changes associated with cerebrovascular disease is critical to improving patient outcomes and quality of life measures. The growing prevalence of remote monitoring tools, from wearable devices to smartphone applications, that facilitate in situ observation of patients and the environments of daily life holds promise for more timely recognition and possible prevention of cerebrovascular accidents (CVA) like stroke. Objective: The goal of this scoping review is to examine and establish categories of innovation with digital sensors that monitor physiological and behavioral variables in situ to augment the current screening and diagnostic processes for patients with cerebrovascular disease. Methods: Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, a robust search strategy for spanning multiple databases from 2012 to September 30, 2022, excluding review articles, articles including interventions, and articles not published in English, was implemented. Among the databases searched were Web of Science; Scopus; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; and Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily. Results: This search strategy aggregated 689 articles, of which 101 (14.7%) articles met the inclusion criteria for this scoping review. Articles were divided into two categories based on their focus: physiological and behavioral. Articles with a physiological focus were sorted into one of nine subcategories according to the signal(s) monitored: motor function, heart rhythm, heart rate, kinematic analysis, physical activity, blood pressure, sensory deficit, electrodermal activity, and intracranial pressure. Articles focusing on behavioral variables were sorted into two subcategories: mood and fatigue. Most studies used an ECG-enabled smartwatch, like an Apple Watch 3, or passive smartphone sensors. Conclusions: This scoping review identified disparate methods and conclusions associated with the use of digital sensors for in situ physiological and behavioral monitoring of cerebrovascular disease patients. While most articles evaluated pilot validation and feasibility trials, the lack of randomized controlled trials is a critical literature gap specific to this evolving research area.
Abstract P407: Sex Differences in Microvascular Response to Mental Stress and Adverse Cardiovascular Events Among Patients With Ischemic Heart Disease
Authors: Samaah Sullivan, An Young, Mariana Garcia, Zakaria Almuwaqqat, Kasra Moazzami, Muhammad Hammadah, Bruno B Lima, Yingtian Hu, Mhmtjamil Alkhalaf, Mohamad Nour Jajeh, Ayman Alkhoder, Lisa Elon, Tene T Lewis, Amit J Shah, Puja K Mehta, J Douglas Bremner, Arshed A Quyyumi, Viola Vaccarino
Journal: Circulation (2023)

Introduction: Microvascular dysfunction during acute mental stress may be an important determinant of major adverse cardiovascular outcomes (MACE) especially among middle-aged women survivors of an acute myocardial infarction (MI). Hypothesis: There are sex differences in the association between microvascular dysfunction and MACE. Methods: The Myocardial Infarction and Mental Stress Study 2 enrolled individuals who had been hospitalized for an MI in the past 8 months at the age of 60 years or younger, with an oversampling of women. Reactive hyperemia index (RHI) was used to measure digital microvascular function before and 30 minutes after a public-speaking mental stress task. This assessment was contrasted with macrovascular endothelial function at the brachial artery through flow-mediated dilation (FMD). Participants were followed for 5-years, and MACE was defined as a composite of cardiovascular death, first/recurring events for nonfatal MI, and hospitalizations for heart failure. Cox proportional hazards models were used to examine vascular response to stress (difference between post-stress and resting values) and MACE adjusting for demographics, clinical risk factors, medications, psychological factors, and mental stress ischemia. Lower RHI and FMD values are indicative of greater microvascular and endothelial dysfunction, respectively. Results: Of 263 participants, the mean age was 51 years and 48% were women. There were 64 patients with 141 adverse cardiovascular events (first and repeated). In the overall sample, there was no significant association between microvascular response to stress and MACE, but there was a significant interaction with sex (p = 0.03). Each standard deviation decrease in RHI response to stress was associated with 50% greater risk of MACE (HR: 1.50, 95% CI: 1.05, 2.13) among women only, while no association was observed in men (HR 0.93, 95% CI: 0.69, 1.26). Transient endothelial dysfunction in response to stress (for each standard deviation decrease in FMD) was associated with 35% greater risk of MACE (HR: 1.35; 95% CI: 1.07, 1.71), and was similar in women and men. Conclusions: Peripheral microvascular dysfunction with mental stress is associated with MACE among women but not among men. In contrast, brachial artery endothelial dysfunction is similarly related to MACE among both men and women. These results suggest that microvascular dysfunction is a female-specific mechanism linking psychological stress to adverse outcomes.
Abstract P646: American Indian Community Stakeholders Evaluate the Cardiovascular Health Curriculum Honoring the Gift of Heart Health: The Strong Heart Study
Authors: Megan Eisele, Jessica Reese, Aimee Jones, Ying Zhang
Journal: Circulation (2023)

Honoring the Gift of Heart Health (HGHH) is a cardiovascular health education curriculum culturally tailored for American Indians (AI). It emphasizes adoption of cardiovascular health recommendations through lifestyle changes. The NHLBI has not revised HGHH components since 2006. Effectiveness of the HGHH may change overtime and updates may be required to influence community health behaviors. Therefore, we aimed to determine the cultural values and practices necessary for inspiring heart healthy behaviors and to make recommendations on including these values and practices in the curriculum. We used a qualitative research design and a narrative inquiry approach. Using snowball sampling, we recruited 11 AI community stakeholders in Oklahoma who participate in the Strong Heart Study. We conducted 3 focus groups with a semi-structured interview guide. We transcribed recordings and conducted a thematic content analysis (Figure 1). Participants viewed written materials as informative but the media as outdated, especially for younger generations, and suggested content ought to be dispersed through various social media. They theorized in-person activities would further educate and motivate community members to be heart healthy, thus adoption of HGHH recommendations more effective. Participants shared concerns about implementing HGHH dietary suggestions while attempting to control food costs, having time constraints, and perceiving food discussed in the program as not representative of what their communities eat. In conclusion, AI community stakeholders advise HGHH updates need to be applicable with current technology, focused on younger generations, coupled with in-person activities, and socio-economically and culturally sensitive to have the most effect. Collecting and evaluating community feedback can guide the development of appropriate updates to the HGHH curriculum. Figure 1 . Theme words identified in focus groups in colored boxes and their related code words in grey boxes.
Abstract P409: Estimating the Effect of Statewide Lockdown Orders on Rates of Acute Coronary Syndrome in the United States
Authors: Brandon M Herbert, Maria M Brooks, Jared W Magnani
Journal: Circulation (2023)

Introduction: Initial statewide responses to the COVID-19 pandemic varied substantially in restrictions and duration. It is known that acute coronary syndrome (ACS) rates declined during the first wave of the COVID-19 pandemic. Whether statewide lockdowns were associated with overall and age-specific declines remains unknown. Hypotheses: 1) Statewide lockdown orders were associated with a reduction in ACS rates and 2) decline in rates of ACS were greater among older individuals. Methods: Individuals with a principal diagnosis of ACS, defined as unstable angina, non-ST elevation myocardial infarction (NSTEMI), and STEMI, were identified between January 2018 and September 2021 using ICD codes in Optum’s de-identified Clinformatics® Data Mart (CDM) Database. Multiple ACS claims from the same individual within 7-days were counted as a single event. Weekly, state-specific ACS rates were calculated by dividing the number of ACS events per week by the number of enrolled CDM members for the corresponding week. Lockdown dates were obtained from government issued orders. The 7-day case rates of COVID-19 were obtained for each state from the CDC COVID Data Tracker and modelled as per 1,000 cases. Generalized estimating equations were used to estimate the effect of statewide lockdowns on ACS rates overall and by age-stratified groups (&lt;45, 45-64, 65-74, and ≥75 years). Results: Across all 50 US states, &gt;17 million patients were enrolled in CDM on average each week (state median: 207,913; interquartile range: 73,510 - 509,593). The mean weekly ACS rate was 17.5 cases per 100,000 enrollees (SD: 10.2). Statewide lockdowns were associated with an 11% decrease in ACS rates (rate ratio [RR]: 0.89 [95% CI: 0.85, 0.94]) after controlling for 7-day case rates of COVID-19 and the peak enrollment month of January. In age-stratified analyses, statewide lockdowns were associated with significant decreases in ACS rates across all age groups: &lt;45 (RR: 0.71 [95% CI: 0.56, 0.90]), 45-64 (RR: 0.80 [95% CI: 0.73, 0.87]), 65-74 (RR: 0.78 [95% CI: 0.69, 0.89]), ≥75 (RR: 0.77 [95% CI: 0.70, 0.84]). Per each 1,000-case increase in COVID-19 case rates, ACS rates declined 18% for those 45-64 (95% CI: 0.75, 0.91) but increased 29% for those 65-74 (95% CI: 1.09, 1.53). Conclusions: Statewide lockdowns were associated with a reduction in rates of ACS. The estimate decline in ACS rates were similar across age groups. Further study is needed to determine if ACS events were prevented by state lockdown periods or if the decline was due to other factors such as competing risks of death.
Abstract P629: Influenza Vaccine Uptake is Associated With Cholesterol Treatment Adherence: An Analysis of the Behavioral Risk Factor Surveillance System Survey
Authors: Samuel D Slavin, Adam N Berman, Prakriti Gaba, Rosangela A Hoshi, Murray A Mittleman
Journal: Circulation (2023)

Introduction: Misinformation, distrust, and other sociocultural factors that influence vaccine uptake may also influence adherence to cholesterol treatment. Hypothesis: Among American adults with hyperlipidemia, individuals who receive influenza vaccination are more likely to report use of cholesterol lowering medication. Methods: We pooled 2017 and 2019 survey data from the Behavioral Risk Factor Surveillance System (BRFSS). Our sample included all respondents aged 40 to 75 years with self-reported high cholesterol. We used logistic regression models adjusted for potential confounders to examine the association between influenza vaccine uptake and use of cholesterol medication. We also evaluated whether the association was different among those with and without established atherosclerotic cardiovascular disease (ASCVD). All analyses accounted for survey weighting. Results: Of 228,338 (weighted = 107,893,277) participants with hyperlipidemia, 51% reported influenza vaccination and 61% reported taking cholesterol medication. Vaccine uptake was associated with cholesterol medication use (OR 2.08, 95% CI 2.00-2.16, p &lt;0.001). Although slightly attenuated, this association persisted after adjustment for socio-demographics, access to care, comorbidities, and adherence to hypertension treatment (OR 1.53, 95% CI 1.42-1.65, p-value &lt;0.001). The association was similar in those with ASCVD (OR 1.63, 95% CI 1.32-2.03, p-value &lt;0.001) and those without ASCVD (OR 1.52, 95% CI 1.40-1.64, p-value &lt;0.001), p-value for interaction = 0.89. Conclusions: Influenza vaccine uptake is associated with cholesterol medication use among American adults with high cholesterol, including those with ASCVD. The sociocultural factors affecting vaccine avoidance, such as misinformation and distrust, merit investigation as potential targets of cardiovascular prevention efforts.
Abstract P513: Adverse Birth Outcomes and Cardiometabolic Outcomes Among Multiracial Children in the U.S.
Authors: Abigail A Allen, Omobola O Oluwafemi, Jenil Patel
Journal: Circulation (2023)

Background: Infant birth weight and preterm birth are prime indicators of health risks in adulthood. Specifically, birth weight and preterm birth have associations with cardiometabolic outcomes. Few studies have shown indications of relationships between high birth weight and cardiometabolic indicators. We aimed to assess the association between cardiometabolic disease and adverse birth outcomes among multiracial children within the United States and within each race/ethnicity group. Methods: Data from the 2016-2019 National Survey of Children’s Health (NSCH) was utilized. The NSCH is a comprehensive survey providing national and state-level data on children’s lives. Post weighting, descriptive statistics on the population were gathered using chi-square tests for comparing the groups. Association analyses were conducted using univariate and multivariable analysis which was adjusted for age, sex, and race. Results: The analyses found that infants with low birth weight have more than two times high odds for heart conditions, a 37% higher likelihood of having diabetes, and were 32% less likely to be overweight. Infants with high birth weight had no associations with heart conditions, but were observed to have a 63% higher likelihood of having diabetes, and are 54% highly likely to be overweight. Infants with preterm birth showed 2.5 times high odds for heart conditions, and are twice as likely to have diabetes, but no associations were found for being overweight. Findings for race and ethnicity showed that for heart conditions there was a consistently higher likelihood (OR &gt; 2) for all race groups within low birth weight and preterm birth. High birth weight was notably higher among Asians with a 63% likelihood, which was close to significant, other categories did not show significance. Preterm birth was 3-times highly likely associated with diabetes among Asians, and 2.4 times higher odds in other race, but not significant among Blacks and Whites. High birth weight had a higher likelihood (46%) among Blacks, compared to 32% among whites. Conclusion: Significant associations among preterm birth, low birth weight, and high birth weight adverse outcomes were observed for certain cardiometabolic health outcomes such as heart conditions and diabetes. There may be other external factors including social determinants of health that have historically affected minorities in the past, and may partly explain our findings.